Unusual Presentation of Stroke-like Symptoms due to Diffuse Infiltrating Glioma with Primary Glioblastoma

Abstract

Background: Gliomatosis cerebri is a rare glioma with poor prognosis and has a non-specific clinical presentation. It has an incidence of 0.1 per 1,000,000 and a median survival of 9 months. Under the latest classification, it is not its own class of tumor, due to a lack of genotypic differentiation from other gliomas. It is considered a unique growth pattern including more than three cerebral lobes. There is no known cause for such extensive invasion of this tumor. Case Presentation: An 81-year-old male presented to a Brazilian hospital with right-sided weakness and speech difficulty consistent with a stroke. In the United States, imaging of the brain showed extensive areas of irregularly thickened signal throughout the cerebral hemispheres and brainstem, consistent with gliomatosis cerebri, and an enhancing mass in the right parietal lobe. There was no evidence of a previous stroke. The patient had a physical exam significant for close to full strength throughout his right upper and lower extremities. The patient underwent a right parietal craniotomy with resection of the right parietal lesion. The patient had an uneventful recovery and was referred to neuro-oncology for further treatment recommendations. Conclusion: There is no current standard of care for gliomatosis cerebri. Treatment for this tumor typically includes chemotherapy and radiation. Surgical intervention of tumor resection is often limited due to the diffuse nature. More research is needed to develop a standard of care for gliomatosis cerebri and discover the unknown etiology of the distinctive growth pattern.